| NPI | 1225293368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4069) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D7613) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2017-02-15 |